Posts Tagged ‘spygelian’

You know you have a problem when T’ai chi hurts. Quite a come down for a guy who’s been doing CrossFit for 10+ years to be so uncomfortable that this ancient Chinese exercise causes enough discomfort that I have to sit down. Oh, it’s nothing exotic or even interesting. I have a companion sports hernia to the one that was fixed 16 years ago (note for CrossFit haters: 6 years prior to discovering CrossFit) to go with a couple of inguinal hernias. A quick little visit to Dr. Google reminds me that weakness in the pelvic floor is an inherited trait. I have a very vivid memory of my Dad joining us for a golf boondoggle wearing a monstrous, medieval apparatus called a truss to hold his hernia in while he played. Again, not CrossFit-related, but definitely messing with my CrossFit Rx for health.

It’s really weird being a patient. On the other side of the stethoscope as it were. I’m not under any illusions that my experience is a run-of-the-mill patient experience. After all, I’m a mid-career specialist who is going to have surgery at the hospital where I’ve operated for 25+ years, one that is run by my own internist and good friend. My surgeon was chosen after talking with the surgical assistants who see everyone operate. They told me who THEY would let operate on themselves and their families. My pre-op testing was arranged around my schedule in a way that was most convenient for me, the patient, and not the hospital, surgeon, or system. I picked my surgical date to coincide with a planned 4-day weekend.

Like I said, not your typical experience heading into surgery.

Nonetheless, this whole patient thing is strange. As a surgeon I am accustomed to being in control of any aspect of the surgical process I care to be involved in. Whether to do surgery and what kind of surgery to do are decisions in my hands. My herniacopia surgery? Not so much. I know that my surgeon is planning laparoscopic surgery, and that both inguinal hernias will be fixed for sure. There’s no way to know the extent of their effect on my most pressing symptoms (see what I did there?), but now that I know they are present I am hyper aware of what they are doing to me in addition to my presenting symptoms. Here’s the rub: I am convinced that it is the Spygelian or sports hernia that’s messing with me, but since it is not obvious on my pre-op CT scan my surgeon is not promising that it will be fixed. There are few things more distressing to a surgeon than not being in control of surgery, and despite all of the wonderful advantages I enjoy because of who I am, what I do, and where it’s happening, this side of the stethoscope is distressing.

What’s the big deal, then? He doesn’t see a hernia he feels is worthy of attention and only does the 2 basic, standard issue inguinal hernias. Less surgery is better than more, right? Sure. Of course it is. Unless it’s not, and that’s the big deal. I had discomfort and weakness as a 40 year old due to a Spygelian hernia on the left side. That hernia was diagnosed by a classic old-school general surgeon without any fancy imaging tests. Just an eerily well-placed index finger and a loudly yelped “YES” when he asked me “does it hurt right here?”, and off to the OR. Why he didn’t fix both sides then I’ll never know, because it was only a matter of time until the right shoe dropped.

Although CrossFit did not cause any of these problems it was definitely CrossFit that let me know I had a problem. Not only that, but it is precisely my performance, both degree and detail, that has convinced me that the Spygelian hernia is enough of an issue to fix. We measure everything in CrossFit. Time, weight, reps. We compare our results with previous efforts as a way of evaluating our fitness, and to some degree to monitor the quality of our workout programming. Gradually, over the course of 12 months or so, I have lost the ability to brace and maintain my mid-line with my abdominal muscles. In a classic cascade of calamity my secondary pelvic support muscles–gluteus medeus, piriformis, obturator, and that rat-bastard the extensor fascia lata–took over and eventually began to fail. At first it was just a little discomfort, followed by a little weakness, ending up in constant cramping and pain in all of them. At this time last year I pulled a lifetime PR in the deadlift; this weekend I could barely do reps at bodyweight.

The first place I felt pain was in that tiny little area that old-school doc poked so many years ago.

Meh. Tough spot, for me or any other patient. I’m not bringing unrefereed information from the internet to the game. I had this same thing 16 years ago, and I have objective data from my CrossFit gym that supports my contention. How best to present this to my surgeon? In this regard I am little different than anyone else with pre-op questions. At our initial visit together I laid out my symptoms and my history. During our post-CT phone call I reiterated my concern about not fixing the Spygelian hernia, however small it might be on direct visualization. Not gonna lie, the thought of having the surgery and continuing to have the same issues when I exercise makes me nauseous.

What’ll I do? Well, I guess this is the place where I really am just like everyone else when it comes to being on this side of the stethoscope. I will just have to have confidence in the surgeon I chose that he will do everything that needs to be done to solve my problem. After all, just like anyone else, I’ll be asleep while it’s going on. Kinda tough to have any input right then, ya know? It will be weeks before I will be able to really test out my results, and those weeks will likely be filled with all sorts of exotic physical therapy exercises geared toward strengthening my abs and accessory muscles, and getting my gluteus maximus to start firing again. Turns out my pain in the ass has actually been a pain in the ass…your glutes turn off in response to losing the ability to brace with your abs.

I am SO ready for this to be fixed, and I’m thinking I feel pretty good about how it’s all going to turn out. If not, well, I’m sure I’ll at least be able to enjoy pain free T’ai chi. My surgeon will undoubtedly take my concerns to heart when he is doing my surgery. After all, we will still share the same side of the stethoscope after the surgery is done.